Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury
Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury
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DOI：
10.7326/0003-4819-140-5-200403020-00009
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发表时间：
2004-03-02
影响因子：
39.2
通讯作者：
Kramer, AM
中科院分区：
文献类型：
--
作者：
O'Brien, JM;Welsh, CH;Kramer, AM
背景：尽管肥胖在成年人中流行，但超重对危重疾病结局的影响尚未得到很好的研究。目的：探讨机械通气急性肺损伤患者体重过重与预后的关系。设计：对急性肺损伤治疗试验参与者进行二次分析。环境：参与国家心肺血液研究所急性呼吸窘迫综合征网络的10个美国医疗中心。患者：902名机械通气患者，纳入急性肺损伤治疗的随机对照试验。干预措施：在特定的断奶方案下，分配较高（12 mL/kg预测体重）或较低（6 mL/kg预测体重）的潮气量通气策略。一些患者还接受酮康唑、异茶碱或安慰剂的析因设计。测量：死亡率、第28天无辅助通气率和无呼吸机天数。结果：肺损伤的间接原因，包括外伤，在肥胖患者中更为常见。超重和肥胖患者在入组前由于较高的潮气量有较高的峰值和平台气道压力。经过风险调整后，超重与死亡、实现无辅助通气或无呼吸机天数无关。这种效果的缺乏在身体质量指数（BMI）的分类或连续测量中持续存在。我们发现呼吸机方案分配和BMI类别之间没有显著的相互作用。结论：经风险调整后，超重和肥胖患者合并急性肺损伤的预后与BMI正常患者相似。呼吸机方案分配与BMI之间缺乏相互作用表明，BMI正常、超重或肥胖的患者可从低潮气量通气治疗急性肺损伤中获益。
Background: Despite an epidemic of obesity among adults, the effect of excess body weight on outcome from critical illness is not well studied.Objective: To examine the association between excess body weight and outcome in mechanically ventilated patients with acute lung injury.Design: Secondary analysis of participants in trials of therapy for acute lung injury.Setting: 10 U.S. medical centers that participate in the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network.Patients: 902 mechanically ventilated patients who were enrolled in randomized, controlled trials of therapy for acute lung injury.Intervention: Assignment to higher (12 mL/kg of predicted weight) or lower (6 mL/kg of predicted weight) tidal volume ventilation strategies with specified weaning protocols. Some patients also received ketoconazole, lisofylline, or placebo by factorial design.Measurements: Mortality rate, rate of unassisted ventilation by day 28, and number of ventilator-free days.Results: Indirect causes of lung injury, including trauma, were more common in obese patients. Overweight and obese patients had higher peak and plateau airway pressures before enrollment because of higher set tidal volumes. After risk adjustment, excess body weight was not associated with death, achievement of unassisted ventilation, or number of ventilator-free days. This lack of effect persisted with categorical or continuous measures of body mass index (BMI). We found no significant interaction between ventilator protocol assignment and BMI category.Conclusions: After risk adjustment, overweight and obese patients with acute lung injury have outcomes similar to those of patients with normal BMI. The lack of interaction between ventilator protocol assignment and BMI suggests that patients with normal, overweight, or obese BMI benefit from lower tidal volume ventilation for acute lung injury.